2010 Winning Essay

2010 A Nurse I Am Scholarship winners were asked to answer the following: The metaparadigm concepts of nursing are person, health, environment and nursing. These terms are generally used to define nursing as a discipline. Pick two nurses from the film and tell how they fulfilled the needs of the patients they cared for using these concepts. Compare or contrast how these 2 nurses use these concepts to the way you plan to use them in your practice as a nurse.

Annie Dien

Saddleback College Nursing Program

The practice of nursing has evolved throughout the years since Florence Nightingale described the discipline as "putting the patient in the best condition to act." So many definitions exist, yet they all fall within the metaparadigm of nursing. The four essential concepts are: person, health, environment and nursing. Depending on the specific needs of the patient, as nurses we must prioritize these concepts and
provide care in a way that best suits the situation. Robert Wilkinson and Mona Counts are two of the exceptional nurses documented in the film, "A Nurse I Am" who draw on these principles everyday.

Bob Wilkinson is a Pediatric Oncology nurse who fumbles around with toy cars just as much as IV lines at the Kosair Children's Hospital in Louisville, Kentucky. In the pediatric wing, Wilkinson focused on the person's spirituality and their environment to put his terminally ill patients in the best condition for nature to act. Physical health is only one aspect of the person, and Bob shows the importance of treating the patient as a human being first. That means going the extra mile to get to know your patient, creating an open dialogue allowing the patient freedom to express feelings, however painful it may be, and being an advocate for their care because the doctors cannot always be at the bedside, but you are. He does this through simple things such as bringing toys to the bedside, making jokes and always having a smile. As nurses, we realize that because we can't always change nature, we must learn how to nurture. In my nursing career there will always be times when medicine will have its limits, and Bob has taught me the importance of offering myself. This may mean spending my breaks at a patient's bedside or watering the patient's flowers for them, but being able to make a patient feel more than just a list of tasks is part of what makes a nurse successful.

Mona Counts is a Nurse Practitioner who runs a Primary Care Center serving a medically underserved community in Appalachia. For many of Counts' impoverished patients, health is a measure of function and embodiment of self-concept, which is especially true for the aging population. Counts addressed the metaparadigm of nursing by focusing on person and health, thus maintaining the person's self-concept and ensuring that her patient is receiving the care they need. Virginia, diagnosed with CHF and entering renal failure, refuses to relocate. Although this makes managing her illness more difficult, her independence and self-concept are preserved by bringing in home health nurses and making house visits. Counts demonstrated how a person's perception of health is not only part of the nursing assessment; it can be a guide to nursing care. However, this can create a thin line between what the patient wants and what a patient needs. As nurses we are educated and experienced in the care and pathophysiology of disease processes while most patients are not. We need to act in their best interest based on our expertise even if it is incompatible with their desires. Critical thinking and good judgment are qualities that every nurse must have in order to care for their patients and prioritize needs. These are skills that I will continually build on during my nursing career.

The four concepts in the metaparadigm of nursing are separate ideas, but they exist independently because each concept affects the other three. Poor self-concept or stress can be a barrier to recovery, therefore if our patient is anxious we need to provide a calm, quiet environment and provide nursing care that is holistic. Wilkinson and Counts are very different nurses yet they maintained the discipline's metaparadigm because they evaluated the patient's needs based on the person, health, environment and nursing. By watching how these nurses assessed their patients' needs in their individual settings, I see how in my own practice I can provide care while respecting the individuality and uniqueness of each person and how they react to life.

Humans, according to Andrews Roy from the Roy Adaptation Model, are "a biopsychosocial spiritual being in constant interaction with a changing environment," and our responsibilities as nurses are to address all these aspects in a way that is unique to each patient and that is what makes nursing a challenging and rewarding career. These skills and talents which make a nurse successful cannot be learned from a book, but from experience and a desire to help others.

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